Bone marrow stimulation and decortication compromise the biomechanical strength of all suture anchors in rotator cuff repair

Footprint preparation is considered an important factor influencing tendon-bone healing and fixation strength in arthroscopic rotator cuff repair. This study aimed to compare the biomechanical characteristics of all-suture anchors following 3 different footprint preparation techniques. Eighteen fresh-frozen human cadaveric shoulders were used. The anterior, middle, and posterior regions of the greater tuberosity were randomly and equally assigned to 3 footprint preparation techniques: remnant-preserving, decortication, and bone marrow stimulation (BMS). A 2.8 mm all-suture anchor was inserted at each designated site. Cyclic loading tests were performed to simulate the traction forces by the rotator cuff. The cyclic displacement, ultimate failure load, number of cycles, failure mode, and cortical defect size were recorded for comparison among groups. The remnant-preserving group demonstrated the highest load to failure (209.6 ± 61.6 N), which was significantly greater than both the decortication (137.2 ± 51.2 N) and BMS (151.6 ± 56.5 N) groups (P = .002). Similarly, the remnant-preserving group withstood significantly more cycles to failure compared with the other 2 groups (P = .003). Suture anchor pullout was the predominant mode of failure in all specimens. The remnant-preserving group also exhibited the smallest cortical defect size (P = .019). Both decortication and BMS techniques resulted in a significant reduction in the biomechanical performance of the suture anchors compared with the remnant-preserving technique.